Provider Demographics
NPI:1790935971
Name:AVATAR HOLDINGS INC.
Entity Type:Organization
Organization Name:AVATAR HOLDINGS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-533-9242
Mailing Address - Street 1:850 TIDEWATER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3300
Mailing Address - Country:US
Mailing Address - Phone:757-533-9242
Mailing Address - Fax:757-533-9634
Practice Address - Street 1:850 TIDEWATER DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-533-9242
Practice Address - Fax:757-533-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003230101YP2500X
VA09040044731041C0700X
VA09040058491041C0700X
VA09040025841041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty